My mother is 90 years old and is in a nursing home. She is suffering from some dementia and is having reoccurring UTIs. After her dr. appointment today her doctor pulled me aside and started talking about some end-of-life decisions. He informed me that most deaths in the nursing homes come from UTIs and pneumonia. He believes that the UTIs my mother is suffering from will be what ends her life and he said this would be the time to continue to treat the UTIs, which would not resolve them and could possibly end her up in the hospital again or to stop treatment and allow her to slip away peacefully. Is this a common practice?
Search bar above, enter CIPRO. There are pages on the dangers of Cipro in the elderly.
Maybe if your Mom is to be made comfortable, another UTI medication could be given.
Pamstegma wrote this:
"Find out what she is on. The FDA has posted warnings on quinolone antibiotics like Ciprofloxacin causing problems like this. Call the MD ASAP"
So I call 911, we go there, wait for 5 hours. Doc there says her blood work is the same as it was upon discharge the last time she was there. He didn't want to admit her because vitals were fine and nothing alarming seemed to be going on. He suggested she take an oral antibiotic again since her UTI was responsive to it last time. He wanted to avoid catheterizing her/admitting her also because that can up the risk of a UTI. So we went home. This was Thursday.
She has been fine so far - eating, drinking. Tired and memory is getting worse, but that's just due to her age and unwellness, IMO.
Anyway, PCP talked to ER doc and she was pissed at him for not taking urine (tho she had just taken it a day or two earlier and we await results) and for discharging her, I guess.
I'm SO confused. Obviously, I don't want to admit her when she doesn't seem outwardly ill. I don't want to take her to the ER any old time. But since she had sepsis once and another UTI that she was admitted for, I'm in a constant state of worrying that I'm being neglectful. That said, the other two times, she had clear symptoms - not eating for a week, severe diarrhea or vomiting, chills.
Hopefully, the Cipro will work. I'm also upset because my mom's senior health center has a program where they provide IV fluids and antibiotics in the home - which would be a blessing, but her insurance doesn't cover it. That makes no sense to me, since it's a lot cheaper than covering ambulance and hospitalization. I'm considering finding out what it would cost out of pocket.
I've never been in a position where 2 docs disagree (in fact ER doc said he'd go with a different antibiotic than Cipro, but PCP wanted that) and where I have to be on constant alert.
I feel like *I* have to make a decision about when I think she needs to go to the ER - i.e., clear symptom of some sort (lack of appetite, fever, diarrhea, vomiting). We can't just pop to the hospital every week! But I'm worried I'll make the wrong call. UGH.
We are going to see a different urologist than the first one we saw about removing her large kidney stone, which is contributing to the UTIs. Procedure requires gen anesthesia and minor surgery, so urologist was concerned that was risky given her overall health/age.
Help!
.. all it takes it's one poor decision made by a physician to take one correctable scenario and turn it into a death sentence of the individual... and then I have watched these physicians sit there and talk their way out of the bad decisions by convincing family members "perhaps we just let nature take its course now" preparing the family of the pending death of the individual. So then, there's almost a relief and a giving up and the family seems eager to enter into that decision. Almost as if hoping the doctor tells them "let's just stop treating.
That Veronica, is what disturbs me. And to be quite frank, it's each humans decision at the end of life to decide for themselves how they go, problem is, we have as you've mentioned, untrained, tired famlies making decisions, decisions for another human and that includes the humans death.
To me, unless the elder is already suffering chronic illness/conditions and regardless treatment of even minor ailments the individual will pass, that is the time to discuss the do not treat ... Listen Folks, or me, "life of the elder should be respected as a right to life, and considered and treated as just as an important decision within these families and these physicians and these facilities, just as much as their death is.
It' seems to me, from what I watch, hear and read, more time and discussions are spent on the decision and planning of an elders death, rather than the decision of the elders life. (And no, I am not speaking of the terminally I'll.)
I believe in personal existence decisions when able to be made by each individual of sound mind and body ..I also believe in the quality of life rather than quantity of life...
... but when the individual can no longer make their own personal critical decisions, I find we as their keepers, should strongly seek the very real moral and the very real spiritual balance for this individual ....weigh both their life and their death equally and carefully for this person, and do not allow our (care givers and family's) own tiredness, our own impatience, and/or our own fed-upness with the elder position we are in, to ever, ever direct a decision of death, nor ever allow that same tiredness or fed-upness to allow a physician, or facility to ever behave the same ... but rather make deeply personal decisions for the individuals existence, or ... ending their existence. it's not supposed to be "they're old, just let them go. your elder regarding treatment? ... I guess everything you do or don't do for another human-being, solely depends on how much you love them or how much you genuinely believe they are valuable in some way. Because there comes a point where allot of control is gone, so making decisions that "fit your life about another's life... just seems very worthy of decisions that are being made are being made as humanly as possible.
Anyway, I suppose all of us are making our decisions based on our very different experiences.
I did go back and re read all the responses and I don't think anyone in this group is high fiveing each other because they see a high horse they can climb on.
As you know caring for an elderly loved one can and usually is very taxing both physically and emotionally.
When the caregiving starts most people are ignorant of the toll it will take on them, they are just anxious to do the right thing by their elder. This is usually based on what they have promised the elder or what they would hope for themselves.
Unless the caregiver is a trained healthcare professional most have no idea about proper care or disease progression and make their decisions based on emotions.
Pneumonia used to be called the old man's friend. This is no longer the case because of modern treatments but it still kills many when developed while someone is actively dying.
We do not know the history of the OP's loved or what stages of disease she may be in.
My understanding from her question is that she was shocked that the Dr should make such an unbelievable suggestion, maybe now she has read some of the responses she understands his reasoning.
There is no right or wrong decision to make in these cases because UTIs frequently become chronic with the bacteria hiding in the convoluted coils of the kidneys only to reappear a few weeks later. My advice would be not to treat anything where the treatment will cause the patient further distress from the treatment.
I was surprised that one writer said that Medicare would not cover IV antibiotics in the home. My supplementary insurance won't usually cover things that Medicare denies but they approved six weeks of IV antibiotics at home when my hip replacement became infected. They put in a permanent IV PICC line in the hospital and my husband gave the daily dose. Yes I did have a tube sticking out of my arm for six weeks and it was a nuisance but there was no pain and it was removed as soon as the course of antibiotics was finished. Most anti biotics have side effects usually related to the GI tract and these can be unpleasant such as continual diarrhea
While I think it is good to reach out and ask questions, it is equally as important to have faith, and follow Dr's advice.
It almost impossible to get all of the information out in a simple post, so when asked in "generalities", you are going to get a lot of imotionally fueled responses, but nobody knows All of the answers, without knowing All of the pertinent patient history, and sometimes not even the caregivers to our LO's do not know All of the patient history and/or what is potentially best for them, that is why we put our trust in, and rely on our Dr's care, in good faith that they know best. There is Never just one true answer!
I hear you, and I do NOT want my mom to die - of anything! The dilemma for us is that her urinary tract is colonized by bacteria and she will most definitely be getting UTI after UTI. Her large kidney stone is a big factor in these infections; it cannot be removed without surgery/general anesthesia, which is risky for someone in her condition.
If the UTIs could be treated easily at home, that would be wonderful, but, unfortunately it is hard to catch them early, plus giving her prophylactic antibiotics isn't good because there are different types of bacteria in UTIs, so not all antibiotics work, and taking them too often can make her resistant to them.
So in the past 4 months, we had to call 911, get her in an ambulance, sit in the ER, and admit her for a week stay in the hospital twice. All of that is so traumatic.
When push comes to shove, would I simply not get her to the hospital? Highly unlikely. So I guess that means accepting that she will probably go to the ER (can't get her there without an ambulance) repeatedly.
There is a service through her senior health clinic that can bring IV fluids and antibiotics into the home, after testing her for the specific bacteria, which would be ideal. Unfortunately, her insurance doesn't cover that.
(Also, the kid with a toothache analogy is not the same. We are talking about very old and very ill people here.)
Treating or not treating a UTI is not a similar decision as the decision of removing life support or carrying out a DNR during a heart attack, etc. Not treating a UTI is nothing I find reasonable under a DNR document or personal/family wish or respect, not when we are speaking of a still living being who is not passing in their death bed from other causes.
But, if an individual with intelligent human beings around them are allowed to die because of a UTI ... big problem.
And I will say it again, My god this subject and some of it's responding comments deeply disturbs me.
UTIs are infections due to several scenarios, and usually correctable scenarios, find what that scenario is for your elder and change the situation... and let them die, when it's their time of no causes or from more untreatable causes, or terminal causes that are out of your control ... a UTI is in your "control (one must read deeper into that, at least I hope.
An elder individual will die from cancers, Alzheimer's, heart or lungs or other serious conditions, and individuals will die from natural causes ... no where, let me repeat, no where is a UTI a natural cause nor a serious condition that stood the precedence to death due to reoccurring events.
If, and I repeat "IF" a physician ever expresses to any of you that your loved one has had too many UTIs to the point you should not treat it and just let them pass, you should dial 3 numbers .... those three numbers are 911 and press charges against that physician of willful neglect, malpractice and a whole host of other charges. This thinking among some of you, albeit I "get where your thoughts come from, I actually do, but just because you or whomever are tired of dealing with the elder is it actually moral to say "no we won't treat for a minor (which could turn major) ailment simply because we're sick of dealing with him or her?? I mean Jesus what the h*ll is that way of thinking, huh??? Anyway, those thoughts of let them die of even such a treatable ailment that I have read on this subject, is exactly how nursing homes, hospice and even assited living facilities are allowed to expedite death and get away with it. I hope I've made myself clear. And by the way I am a firm believer of quality not quantity of life, but equally a believer of human rights.
When she was in rehab at a NH, there were so many people (99 percent women) who were cleaned, dressed, fed, and parked in their wheelchairs in the world's most depressing, flourescently-lit room day after day, staring blankly into space or yelling or pulling their pants down. Hopefully, they weren't suffering, but, boy, their loved ones sure were. Why do we do this to humans when we would never put our pets through this? What is the point?
To be admitted there must be a terminal diagnosis with the expectation that the patient will die within six months.
They will continue medications for the admission diagnosis as long as it is beneficial for the patient. Other conditions remain the responsibility of the patient and family. If the diagnosis is heart failure but the patient also is diabetic they do not supply those medications but will offer helpful advice and visit if there is a crisis.
Things like infections may or may not be treated depending on the patient's general condition and the wishes of patient and POA. If family does not agree with hospice decisions they are free to have the patient discharged and seek more aggressive treatment. There is not a problem with readmission after treatment. Hospitalization and visits to the ER are strongly discouraged and can lead to the patient's discharge from hospice. Sometimes these are deemed necessary by the RN for many reasons in which case it has no impact on the patient's status with hospice.
Every few months there is a five day respite when the patient can go to a hospital or NH to give the caregiver a break. Hospice nurse continues to follow patient and has to approve changes in treatment.
These are always difficult decisions to make and there is no right or wrong choice and there should be no guilt. After all there is no way of knowing the outcome of a different decision. The wishes and welfare of the loved one are the primary goal.
They are preparing to die and that situation must be respected however much the caregiver wishes otherwise. You can only do your best.
Getting a clean catch and having it cultured is the only way to know which antibiotic is the correct one. She had been taking the wrong ones for years, as the bacteria she had was a very rare one, according to the doctor. Many months have gone by without a new infection developing, and when one did, I had them use this method again. After all, how "comfortable" is a UTI, as painful as it is, especially when it leads to seizures.